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A Hospital-Discharge Planning Checklist

For patients and their caregivers preparing to leave a hospital, nursing home, or other care setting

During your stay, your doctor and the staff will work with you to plan for your discharge. You and your caregiver(s) - family member or friend who may be helping you - are important members of the planning team.

Below is a checklist of important things you and your caregiver(s) should know to prepare for discharge. Use this checklist early and often during your stay. Talk to your doctor and the staff (which could be a discharge planner, social worker, or nurse) about the items on the checklist.

Use the notes column to write down important information (like names and phone numbers). Skip any items that don’t apply to you.

ACTION ITEMS NOTES

1. What’s Ahead?

Ask where you will get care after discharge. Do you ________________________ have options (like home health care)? Be sure you ________________________ tell the staff what you prefer.

If a caregiver will be helping you after discharge, ________________________ write down their name and phone number.

2. Your Health

Ask the staff about your health condition and what ________________________you can do to help yourself get better.

Ask about problems to watch for and what to do ________________________about them. Write down a name and phone number ________________________to call if you have problems.

Use “My Drug List” (scroll down) to write down _______________________your prescription drugs, over-the-counter drugs,vitamins, and herbal supplements. Review the list with the staff.

Tell the staff what drugs, vitamins, or supplements you took before you were admitted. Ask if you should still take these after you leave.

Write down a name and phone number to call if you have questions. _______________________

3. Recovery and Support

Ask if you will need medical equipment (like a walker). ________________________

Who will arrange for this? Write down where to call if ________________________you have questions about equipment.

Ask if you’re ready to do the activities listed below. ________________________

Circle the ones you need help with and tell the staff.• Bathing, dressing, using the bathroom, climbing stairs • Cooking, food shopping, house cleaning, paying bills • Getting to doctors’ appointments, picking up prescription drugs

Make sure you have support (like a caregiver) in place ________________________that can help you.

Ask the staff to show you and your caregiver any ________________________other tasks that require special skills (like changing ________________________a bandage or giving a shot). Then, show them you ________________________can do these tasks. Write down a name and phonenumber to call if you need help.

Ask to speak to a social worker if you’re concerned ________________________about how you and your family are coping with your ________________________illness. Write down information about support groupsand other resources.

Talk to a social worker or your health plan if you ________________________have questions about what your insurance will cover ________________________and how much you will have to pay. Ask aboutpossible ways to get help with your costs.

Ask for written discharge instructions (that you can read and understand) and a summary of your current health status. Bring this information and your completed “MyDrug List” to your follow-up appointments.

Use “My Appointments” (scroll down) to write down any ________________________appointments and tests you will need in the nextseveral weeks.

4. For the Caregiver

Do you have any questions about the items on this ________________________checklist or on the discharge instructions? Writethem down and discuss them with the staff.

Can you give the patient the help he or she needs? ________________________

What tasks do you need help with? ________________________

Do you need any education or training? ________________________

Talk to the staff about getting the help you needbefore discharge.

Write down a name and phone number to call if you have questions. ________________________

Get prescriptions and any special diet instructions early, _______________________so you won’t have to make extra trips after discharge.

Now it's time to create and fill out a list with all prescription drugs, over-the-counter drugs, vitamins, and herbal supplements you take. Review this list with the staff.

MY DRUG LIST Filled out on: ____________________

Be sure to include:

Drug Name What it Does Dose How to take it When to take it Notes

____________________

Finally, make and create a list of future appointments.

MY APPOINTMENTS

Be sure to include: Appointments & Tests DatePhone number

Adapted by Personal Safety Nets® from Medicare® Medicaid® and other sources.